Open Distal Femoral Physeal Fracture in a 6-Year-Old Child Complicated by Growth Arrest and Limb-Length Discrepancy:...

Distal femoral physeal fractures are rare and particularly uncommon in very young patients, as they typically require a significant amount of kinetic energy. They carry a high risk of premature physeal closure and later growth disturbance. We aimed to describe the management and long-term outcome of an open distal femoral physeal fracture in a 6-year-old child.

We report a previously healthy 6-year-old child sustained an open distal femoral physeal fracture in an electric scooter-motor vehicle collision. Emergency treatment included trauma assessment, resuscitation, intravenous cefazolin, urgent irrigation and debridement, open reduction, crossed smooth Kirschner-wire fixation, and immobilization. Long-term follow-up included growth prediction using the multiplier method.

The injury was classified intraoperatively as a Salter-Harris type I distal femoral physeal fracture. Despite timely surgical treatment, progressive limb-length discrepancy developed, increasing from 1.3 cm at 10 months to 6.5 cm over 5 years. Growth prediction estimated a final discrepancy of 7.32 cm at skeletal maturity, and contralateral distal femoral epiphysiodesis was performed. The literature confirms that displaced high-energy distal femoral physeal injuries in younger children carry a substantial risk of premature physeal closure and later corrective surgery.

Open high-energy distal femoral physeal fractures in young children are limb-growth-threatening injuries. This case demonstrates that satisfactory initial fracture management does not eliminate the risk of later premature physeal closure, and that clinically important discrepancy evolves gradually over several years. Long-term follow-up and growth prediction are essential to guide timely corrective treatment to minimize the leg-length discrepancy in bone maturity.